NR 573 Week 6 Team Communication Debrief Example

Team Communication Debrief: An Instruction Given to the Room, a Saturation Said Once and a Concern Asked as a Question During a Simulated Tension Pneumothorax

Student Name

College of Nursing, Chamberlain University

NR 573: Advanced Acute Care Management Lab

Instructor Name

Month Day, Year

Team Communication Debrief: An Instruction Given to the Room, a Saturation Said Once and a Concern Asked as a Question During a Simulated Tension Pneumothorax

Scenario and Roles

Simulation laboratory, acute care lab session 5: a ventilated 64-year-old whose peak airway pressure rose suddenly 40 minutes after a left subclavian line, later found to have a tension pneumothorax. Roles: leader (me), bedside nurse, respiratory therapist and recorder. The exchange below is rebuilt from the session video and transcribed with the faculty's permission; roles are given by function only.

Exchange 1: A Concern Raised as a Question

00:48. Bedside nurse, while I was watching the suction catheter: "Are the breath sounds a bit quiet on the left?"

00:50. Leader: "Let's see if suction clears it."

01:05. Bedside nurse, listening again, says nothing.

01:10. Leader, after listening: "No air entry on the left."

Shape of the failure: the most important finding of the scenario was offered at 00:48 as a question. I answered a different question, whether suction would work, and the nurse did not repeat it. Interval: 22 seconds from the concern to my listening. Type: an assertion softened into a question, and a leader who treated it as optional. A framework for structured assertion suggests stating the concern in words that require a response, such as "I am concerned; breath sounds are absent on the left" (Leonard et al., 2004).

Exchange 2: An Instruction Given to the Room

01:15. Leader, looking at the patient: "Can someone get me a decompression needle?"

01:15 to 01:35. Respiratory therapist is bagging. Bedside nurse is checking the blood pressure. Recorder is writing.

01:35. Leader: "Do we have the needle?"

01:38. Bedside nurse: "I thought you were getting it." Leaves to get it.

01:40. Needle at the bedside.

Shape of the failure: an instruction addressed to nobody in particular was heard by everyone and taken by no one. Interval: 25 seconds from the request to anyone moving. Type: an instruction with no named receiver and no check-back. In a study of trauma teams in simulation, call-outs averaged about 20 per team but closed-loop exchanges, where an instruction is acknowledged and its completion reported, fewer than 3 (Härgestam et al., 2013).

Exchange 3: A Number Said Once

00:52. Respiratory therapist, quietly: "Sats eighty-five."

01:10. Respiratory therapist: no update.

01:25. Monitor shows 82%. No one says it.

Shape of the failure: the saturation was reported once, early, and then the team relied on the alarm. No one confirmed the number or repeated it as it fell. Type: a critical value stated without acknowledgment and not tracked aloud.

The Person Who Noticed and Stayed Quiet

The recorder told the group afterward that at 00:30 they had noticed, on the scenario sheet, that the line placed 40 minutes earlier was in the left subclavian vein, and had wondered about a pneumothorax. They said nothing, because they were in the recorder role and assumed the leader had read the sheet. I had not connected the line to the pressure until 01:10. Their silence is part of the record. It is not a fault in the recorder; it reflects a team where observations were expected to come only from those at the bedside.

What Went Well in the Same Three Minutes

The same recording shows communication that worked. When I said at 01:10, "No air entry on the left, I think this is a tension pneumothorax, I am going to decompress," the respiratory therapist answered, "Tension pneumothorax, decompress, I'll keep bagging," which is a full closed loop. The nurse called out the needle site aloud before I placed it, and I confirmed it. After decompression, the respiratory therapist called each new saturation as it rose. These moments show the team could do it; the failures came in the first minute, before anyone had a shared name for the problem. Once the problem had a name, instructions found receivers almost automatically, which suggests the fixes matter most in the uncertain opening of a scenario, when nobody yet knows what the problem is called.

The Failures as Types, Each With a Fix

Assertion softened into a question: the leader asks the team at the start, "If you see something, say it as a statement and I'll stop and answer it." Instruction to the room: every instruction goes to a named role, "Nurse, get the decompression needle," and the receiver repeats it and reports when it is done. Critical value said once: the respiratory therapist calls the saturation every 30 seconds until it is rising, and the leader acknowledges each call. Silent observer: the recorder is given an explicit second job, to read the scenario sheet aloud at the start and to call out anything on it that the leader has not mentioned.

None of these fixes is better communication in general. Each names who does what, at what moment, in which words.

How the Team Agreed to Practice the Fixes

At the end of the debrief the four of us agreed on three changes for the next scenario, and the faculty member wrote them on the board. The leader will open by saying, "Speak up as a statement; I will stop and answer." Every instruction will name a role and be repeated back. The recorder will read the stem aloud in the first 30 seconds. We will measure the result the same way, from the video, so the next debrief can compare the intervals. If the gap from concern to action is shorter next time, the fixes worked; if not, we will look again at what got in the way, rather than adding more rules.

Size of the Failures

The three failures overlapped in a scenario that lasted three minutes. From the nurse's question at 00:48 to the needle in place at 01:40 was 52 seconds, of which about 47 can be attributed to the first two exchanges. In a real patient with tension physiology and a falling pressure, 47 seconds is not trivial.

Sources

Assertion phrases and structured communication tools come from the teamwork literature on safe care (Leonard et al., 2004). The rarity of closed-loop exchanges even in trained teams comes from the trauma simulation study cited above (Härgestam et al., 2013). The three phases of the simulation debriefing standard, reaction, analysis and summary, give this debrief its order (Decker et al., 2021).

References

Decker, S., Alinier, G., Crawford, S. B., Gordon, R. M., Jenkins, D., & Wilson, C. (2021). Healthcare Simulation Standards of Best Practice: The debriefing process. Clinical Simulation in Nursing, 58, 27-32. https://doi.org/10.1016/j.ecns.2021.08.011

Härgestam, M., Lindkvist, M., Brulin, C., Jacobsson, M., & Hultin, M. (2013). Communication in interdisciplinary teams: Exploring closed-loop communication during in situ trauma team training. BMJ Open, 3(10), Article e003525. https://doi.org/10.1136/bmjopen-2013-003525

Leonard, M., Graham, S., & Bonacum, D. (2004). The human factor: The critical importance of effective teamwork and communication in providing safe care. Quality and Safety in Health Care, 13(Suppl. 1), i85-i90. https://doi.org/10.1136/qshc.2004.010033